What measures has the government implemented to regulate hysterectomy rates? What are the available treatment options?
The Union Health Ministry has recently urged State governments to conduct audits of hysterectomy rates in both public and private hospitals. This action was prompted by a Supreme Court petition highlighting concerns that women from marginalized areas are vulnerable to unjustified hysterectomies, driven by economic motives and exploitation. The Court has directed States to implement the guidelines previously issued by the Centre within three months.
According to NFHS-5 data, the main reasons cited for hysterectomies include excessive menstrual bleeding or pain (51.8%), fibroids (24.94%), cysts (24.94%), and uterine disorders or ruptures (11.08%). However, studies indicate that many of these conditions could be treated without surgery. Socially and economically disadvantaged women are disproportionately affected by unnecessary hysterectomies. Private clinics seeking financial gain, particularly through insurance claims, as well as contractors in unorganized sectors like sugarcane cutting, where menstruation-related care and hygiene pose challenges, are implicated in the misuse of the procedure.
To address this issue, the Union Health Ministry issued guidelines in 2022 that specify potential indications for hysterectomy and recommend alternative clinical treatments for gynaecological issues. They also proposed the establishment of district, state-level, and national hysterectomy monitoring committees to collect data on age, mortality, occupations, and other relevant details. These committees are tasked with raising awareness among practitioners and patients about the role of the uterus and when hysterectomies are truly necessary. However, experts note a lack of awareness and comprehensive sexual and reproductive health education, leading to inadequate "informed consent" for the procedure.
The implementation gap persists due to a cultural lack of awareness and understanding surrounding gynaecological care and disorders beyond pregnancy. Private hospitals in Bihar, Chhattisgarh, and Rajasthan have been accused of engaging in unethical practices, unnecessary procedures, and failing to inform women about potential side effects or seek their informed consent. The availability and affordability of follow-up care and post-operative support for long-term injuries and disabilities resulting from hysterectomies remain major concerns. Hormone replacement therapies and other necessary interventions often remain limited to private hospitals, making them unaffordable for low-income groups.
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